Abstract

There is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP. We conducted a retrospective observational study of data that were prospectively collected for adult patients diagnosed with pneumococcal CAP at our university teaching hospital over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997–2001, 2002–2006, 2007–2011, and 2012–2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU stays, ICU mortality, and need of mechanical ventilation. From a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age ≥65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%–9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38). In this large prospective cohort study of adults hospitalized with pneumococcal CAP over a 20-year period, we found no evidence that 30-day mortality had decreased over time.

Highlights

  • Community-acquired pneumonia (CAP) continues to have high global morbidity and mortality rates, and is associated with considerable health costs[1,2]

  • We observed a decrease in intensive care unit (ICU)-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38)

  • Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated

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Summary

Introduction

Community-acquired pneumonia (CAP) continues to have high global morbidity and mortality rates, and is associated with considerable health costs[1,2]. Some recent published studies have reported that the incidence of CAP has risen in the last decade[3,4], with an increase in the rate of hospitalization. The trend in CAP mortality over recent decades is more controversial, and it was recently stated that mortality in patients hospitalized for CAP has declined over time[5,6,7]. Mortality has declined for a variety of conditions over recent decades, including for sepsis, myocardial infarction, and stroke[14,15], suggesting that better clinical management and improved healthcare are responsible[5,6,7]. There is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP

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Results

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